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DualConnect (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DualConnect (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DualConnect (HMO D-SNP) in 2025, please refer to our full plan details page.
DualConnect (HMO D-SNP) is a HMO D-SNP plan offered by SANTA CLARA COUNTY HEALTH AUTHORITY available for enrollment in 2025 to people living in Santa Clara County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that DualConnect (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DualConnect (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DualConnect (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For DualConnect (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.70. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $8650.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The DualConnect (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). Those with LIS will pay $29.70 for Part D. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The DualConnect (HMO D-SNP) plan offers a variety of benefits with varying cost-sharing structures. Many services, including outpatient, primary care, and vision services, have a 20% coinsurance. Preventive services are covered with no copay, while emergency services also have no copay. The plan also provides additional benefits like home health services with no copay or coinsurance, and coverage for medical equipment and dental services with a 20% coinsurance. Other benefits include coverage for hearing exams, and some coverage for home infusion bundled services. This plan may be a good choice if you want a plan with a range of benefits, but be aware of the coinsurance costs for many services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days for acute and psychiatric care, and non-Medicare-covered stays for acute and psychiatric care, are not covered. The plan requires prior authorization and the coinsurance is defined by Original Medicare.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered under the DualConnect (HMO D-SNP) plan. You will pay a 20% coinsurance for outpatient hospital services, observation services, outpatient blood services, and both individual and group sessions for outpatient substance abuse services.
Partial Hospitalization See details
Partial Hospitalization is covered under the DualConnect (HMO D-SNP) plan, but requires prior authorization and a doctor's referral. You will be responsible for a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the DualConnect (HMO D-SNP) plan. Ground and Air Ambulance Services are covered with a 20% coinsurance, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the DualConnect (HMO D-SNP) plan, with a 20% coinsurance for emergency services and urgently needed services, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The DualConnect (HMO D-SNP) plan covers Primary Care services, with a 20% coinsurance for Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services. Occupational Therapy, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are also covered with a 20% coinsurance.
Preventive Services See details
Preventive services include Medicare-covered services with no copay and additional preventive services that are covered, though annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered. Additional services such as Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing Services are partially covered under the DualConnect (HMO D-SNP) plan. Hearing exams require a doctor referral and have a coinsurance of at most 20%, while routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
The DualConnect (HMO D-SNP) plan covers vision services, including routine eye exams with a 20% coinsurance and eyewear with a combined maximum of $200 every two years. Contact lenses and eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, but orthodontic services are not covered. For Medicare Dental Services, you are responsible for 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the DualConnect (HMO D-SNP) plan, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a 20% coinsurance. Prosthetic devices and diabetic supplies also have a 20% coinsurance. Medical supplies have a 20% coinsurance. Diabetic therapeutic shoes/inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The DualConnect (HMO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay for these services, but you pay coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the DualConnect (HMO D-SNP) plan with no copay and no coinsurance, but require prior authorization and a referral. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the DualConnect (HMO D-SNP) plan. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the DualConnect (HMO D-SNP) plan, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor's referral are required, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
Other services include Over-the-Counter (OTC) Items, with a maximum benefit of $150.00 every three months; however, acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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